Why we studied this topic
Scaling up complex public health interventions is a significant investment for governments, so it is important to be sure there is evidence the programs will work at scale before such an investment is made. But even though there is plenty of evidence for how to scale up programs successfully, we didn’t know the extent to which this advice was followed in public health.
What was surprising?
We conducted an international literature review of 40 complex public health programs in high-income countries that have been scaled up or implemented at scale. We found that in many cases (45%), the scaling up did not follow all the steps we know are important to ensure they are based on evidence. In fact, some programs went directly from the development stage to population-wide dissemination – without efficacy testing or a real-world trial.
What this paper adds
This study was the first to classify and quantify the different ways that public health programs in high-income countries are scaled up to reach the broader population.
What it means for policy
There are many contextual factors that may lead to a program being scaled up. In the paper, we have identified steps that will assist policy makers and practitioners to use best practice when scaling up public health programs.